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Rank: Advanced Member  Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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I am still trying to get on with leflunomide and other bits for three months. I am struggling with pred. at 2.5mg hence having alot of pain mainly forearms and elbows at the moment. I took some co-codamol in the night and stupidly took some tramadol too soon after I think, and have felt quite rough, so to speak all day.
I have had a good read on the site under " painkillers " and found this article. I would be grateful for your thoughts about this as I only take them when at my worse, possibly the wrong move.
Medications for pain
All pain relief medication should be taken at regular intervals when you are trying to get effective pain control. Many people make the mistake of only taking their tablets to relieve pain when the pain is very bad and then wonder why the tablets have not worked. The brain is sensitive to pain messages from the body and if you only take medication occasionally the brain will not be able to produce enough natural pain killer to 'turn off' the 'help I have pain' messages sent from the painful areas to the brain. Regular pain relief helps to break the cycle of pain messages going from the painful joints to the brain.
Many thanks
Julia x
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hey Julia! The article hits the nail on the head! I think we all try to keep off the painkillers as much as possible in the belief that they are yet more 'toxins' floating about our systems. We have to take the Leflunomide, Methotrexate, Prednisolone or whatever our main drug regime is but painkillers are often regarded as a kind of optional extra to be taken as required. I regularly take painkillers, and have done so for many years, and must say for the main part I am relatively pain free, unless some bit decides to have a field day, which happens sometimes!! I take 2 co-dydramol (10mg codeine/500mg paracetamol) tablets after breakfast. At bedtime I take 2 dihydrocodeine (30mg codeine/500mg paracetamol) tablets which are stronger and good for helping me to settle and get off to sleep. I always take these four tablets, regardless of how I feel, pain or no pain. Additionally I might take 1 or 2 co-dydramol during the day if needed. This works for me! It's not recommended that Tramadol and Cocodamol are taken in combination, although they do work in different ways. Tramadol is strong and best saved for bedtime. Cocodamol can be used 4-6 hourly throughout the day. Might be worth taking the maximum to try to get the pain under control and then try to cut down 1 or 2 of the daytime tablets. It's possible that a more suitable painkiller might be more beneficial or that the prednisolone has dropped below a suitable maintenance dose (mine's 3mg, less than that and its mayhem!!!). Worth trying to keep the pain relief level up high for a while and see if it settles down. All very much trial and error until you find what's right for you Julia. Hope it helps you though.  Good to chat again  Lyn x
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,110 Location: London
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Hi Julia, I m on tramadol 100mg x 4, which I am supposed to take 500mg paracetemol at the same time. I changed it to cocodamol 8/500mg which I bought myself in the pharmacy, as the paracetemol are useless. I dont find this combination any better to be honest. I get pain every day, and most of the day really, I know everyone says tramadol are really good, but I dont find them any better than plain paracetemol. Maybe its just me, and the fact of working a physical job. I do believe as Lyn says that you need to keep them in your system however, its no use taking just one lot per day and expecting them to work. Its a hard one, no one enjoys constantly taking meds, but if it helps, then it has to be, take care x BARBARA
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Rank: Advanced Member Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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Thanks Lyn for your reply, I am very grateful indeed for your sound advice. I will now work out my regime very much based on your plan. You have really made my day !  Hope you have a nice sunny Sunday, thanks once again. Julia xx
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Rank: Advanced Member Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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Hi Barbara
Thanks for your advice, it now makes sense that you need to take them regularly. There s nothing worse than constant pain, and like you say no one likes to take them, but their is no choice really. we are all different and what agrees with one doesn t always agree with another.
I hope the pain can ease for you, its all a juggling act to a degree.
Julia x
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,740
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Hello I got my self into a routine find if i break it,re wanting go without to many pills consciense,i get the out of contol pain. take 2 morning,and find depending day im having might only need 2 again teatime and 2 or 1 bedtime. some days if good day il take only 1 at time. good question to ask. i cartn take strong ones if got out and be functional. its a balcning act to what suits you. many types pain relief. im on lower end of scale with a range of 2 one for mild pain 1 for strong carnt bear it pain and the mild ones if got amedium level pain take 2. hope some help. took me a while to sort this out for myself. melly cuddly cats make my world seem so much more fun
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Rank: Advanced Member Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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Thank you Melly, that is of great help and can now understand it will take a while to get it right. Through going into this last night realised the last lot of cocodamol was only 8mg and not 30mg ! Like Barbara, who wrote yesterday I took Tramadol in the night and didn t help me much either, just shows we are all different ( mind you wouldn t be any good all being the same - bit boring !! )
Have a good day,
Julia x
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 838 Location: Nottinghamshire
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When I first started with RA before I was DX I took over the counter painkillers when ever I needed them. To be honest they really didn't make much difference. I wasn't one to normal reach for painkillers so at the time I didn't realise that you could take paracetamols and bruffen together. When I first saw the consultant he prescribed me slow release painkillers, telling me to take one morning and evening so I would have constant pain releif in me to help me 'function normally'. (Thats how he put it) Telling me to take them all the time and not miss a dose so I would always have it in my system.
Last November when things RA wise started to get worse my specailist nurse told me to see my GP to get the prescribed painkillers changed saying that sometimes a change of tablets could work. My GP refused to change them saying it wasn't her place and that the consultant should do it (I think sometimes GP's don't like getting involved too much with RA because they don't really know much about it). But she did prescribed me paracetamols saying that they were a much underestimated drug and worked well if taken on a regular basis.
I did once ask at the chemist about my slow release pain killers, asking how long they stop in my system. Was told that each tablets would last for 24 hours and because I was taking them with around a twelve hour gap in between I would have a good build up of the drug in me, when one started to wear off the other one would start to work (the printed instructions in the box does say to take two together in the morning).
I still can't understand though that if the RA is undercontrol why we still have to take painkillers.
Paula x x
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Rank: Advanced Member Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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Hi Paula
Thanks for your message, nobody GP s etc. have never brought up the subject of painkillers, and now can t quite understand why as they seem so fundamental with our care. I don t know what slow release painkillers are even but with have a look on Google - will explain all. I personally don t think paracetemol for RA are sufficient but I suppose that is debatable, I think I will try to work on 30mg dose of cocodamol two morning and two at night, do give constipation but will have to eat more fruit/veg need to anyway really.
As you say about not understanding why they are necessary when RA is under control. that is why I suppose i haven t gone down this path before, I m certainly glad I had a look into all this, the advice you have given has made me feel much more positive about the future as I have felt pretty low - as we all know pain is so debilatating to say the least.
Take care
Julia xx
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